Scotland

Our reference in a previous chapter to the singular superstitions
connected with the treatment of the insane in Scotland, renders it
unnecessary to do more than point out in this place the substratum of
popular opinion and feeling, upon which the infusion of new ideas and a
scientific system of treatment had to work. To some extent it was the
same in other countries, but judging from the records of the past, as
given or brought to light by writers like Heron, Dalyell, and Dr.
Mitchell, no country ever exceeded Scotland in the grossness of its
superstition and the unhappy consequences which flowed from it. When we
include in this the horrible treatment of the insane, from the prevalent
and for long inveterate belief in witchcraft, we cannot find language
sufficiently strong to characterize the conduct of the people, from the
highest to the lowest in the land, until this monstrous belief was
expelled by the spread of knowledge, the influence of which on conduct
and on law some do not sufficiently realize.

The lunatic and the witch of to-day might aptly exclaim--

"The good of ancient times let others state;
I think it lucky I was born so late."

As regards the property of the insane, the Scotch law, from a remote
period, appears to have been that the ward and custody of it belonged to
the prince as pater patriae. In the beginning of the fourteenth
century, the keeping and custody of persons of "furious mind," by a
statute of Robert I., devolved upon their relatives, and, failing them,
on the justiciar or sheriff of the county. The custody of "fatuous
persons" is said to have been committed to the next agnate (nearest male
relative on the father's side), while that of the "furious" was
entrusted to the Crown, "as having the sole power of coercing with
fetters."[227]

An Act passed in 1585, c. 18, in consequence of abuses in regard to the
nominations of tutors-at-law, provided that the nearest agnate of the
lunatic should be preferred to the office of tutor-at-law. The practice
was originally to issue one brieve, applicable to both furiosity and
fatuity. The statute just mentioned continues the regula regulans, as
to the appointment of tutors-at-law for lunatics.

Passing over two centuries, I must observe that in 1792 Dr. Duncan (the
physician mentioned at p. 122 of this work), then President of the Royal
College of Physicians of Edinburgh, laid before that body a plan for
establishing a lunatic asylum in the neighbourhood of Edinburgh. That
plan, after due consideration, met with the unanimous approval of the
Colleges of Physicians and Surgeons, and a subscription was at once set
on foot to carry it into execution, nearly every Fellow of both Colleges
contributing something. But enough money was not then raised to start
the project in a practical way. Fourteen years afterwards, the attention
of the legislature was directed to the provision for the insane in
Scotland, when (in 1806) an Act (46 Geo. III., c. 156) was passed for
appropriating certain balances arising from forfeited estates in that
country to two objects, not apparently allied--the use of the British
fisheries and the erecting a lunatic asylum in Edinburgh--ichthyology
and psychology. The Act provided, among other clauses, that the Barons
of Exchequer should pay out of the unexhausted balance or surplus of the
moneys paid to them in 1784, by the Act 24 Geo. III., c. 57 (relating to
forfeited estates placed under the board or trustees), the sum of L2000
to the city of Edinburgh towards erecting a lunatic hospital. A royal
charter was obtained in 1807, and subscriptions were raised not only
from Scotland, but England, and even India, Ceylon, and the West Indies.
Madras alone subscribed L1000. The idea of the originators of the
institution was a charitable and very far-reaching one. They made
provision for three classes--paupers, intermediate, and a third in which
the patient had a servant to attend him. It may be mentioned that the
establishment of the Retreat of York and its success were constantly
referred to in appealing to the public for subscriptions. The building
which is now the "East House" was opened in 1813, and the plan of that
building was greatly superior to the prison-like arrangement of some of
the asylums built twenty or thirty years afterwards. From the beginning
the teaching of mental disease to students was considered, as well as
the cure and care of the inmates. The management was a wise one. There
were three governing bodies--the "ordinary managers," for transacting
the ordinary business; the "medical board" of five, consisting of the
President and three Fellows of the Colleges of Physicians and Surgeons;
and the "extraordinary managers," consisting of official and
representative men in and about Edinburgh, who had, along with the
ordinary managers, the election of the board every year. At first there
was a lay superintendent and visiting physicians.

Then there was an Act "regulating mad-houses in Scotland" (55 Geo. III.,
c. 69), passed in the year 1815--that important epoch in lunacy
legislation in the British Isles--brought in by the Lord Advocate of
Scotland (Mr. Colquhoun), Mr. W. Dundas, and General Wemyss, and which
received the royal assent, after several amendments from the House of
Lords, June 7, 1815.

This Act provided that sheriffs should grant licences for keeping
asylums; that no person should keep one without a licence; that the
money received for licences should form part of the rogue money in the
county or stewartry, and that out of it all the expenses required for
the execution of the Act should be defrayed; that inspectors should be
elected within a month after the passing of the Act, and thereafter
should annually inspect asylums twice a year--four by the Royal College
of Physicians in Edinburgh from their ordinary resident members, and
four by the faculty of physicians and surgeons in Glasgow from their
ordinary resident members; that sheriffs should ascertain whether
patients are properly confined; that the sheriff should make an order
for the reception of lunatics, upon a report or certificate signed by a
medical man (no statutory form was ordered for the medical certificates
or the warrants of the sheriffs; a medical man signing a certificate
without due examination of the patient was to forfeit L50); that the
sheriff or stewart might set persons improperly detained at liberty;
that a licence might be recalled upon report made to the sheriff by two
of the inspectors; that the sheriff might make rules for the proper
management of asylums; that the Act should not extend to public
hospitals, nor to single patients; that the Procurator Fiscal should
enforce the Act and recover penalties. The friends of patients were
required to pay an annual fee L2 2s.

Such were the main provisions of this Act, which proved to be an
important advance in the right direction, though far from perfect. It
was amended by 9 Geo. IV., c. 34, and 4 and 5 Vict., c. 60. The three
Acts were repealed and other provisions made by the 20 and 21 Vict., c.
71, an "Act for the Regulation, Care, and Treatment of Lunatics, and for
the Provision, Regulation, and Maintenance of Asylums."

I may add here, though anticipating the future course of events, that
the General Board of Commissioners in Scotland was established by the
Acts 20 and 21 Vict., c. 71, and 21 and 22 Vict., c. 54, both Acts
being amended by 25 and 26 Vict., c. 54, and 27 and 28 Vict., c. 59, the
latter continuing the appointment of Deputy Commissioners, and making
provisions for salaries, etc. The statutes now in force in Scotland are
the 20 and 21 Vict., c. 71; 21 and 22 Vict., c. 89; 25 and 26 Vict., c.
54; 27 and 28 Vict., c. 59; Act for the protection of property of
persons under mental incapacity, 12 and 13 Vict., c. 51; Act providing
for the custody of dangerous lunatics in Scotland, 4 and 5 Vict., c. 60
(repealed and other provisions made by fore-mentioned Acts); Act to
amend the law relating to lunacy in Scotland and to make further
provision for the care and treatment of lunatics, 29 and 30 Vict., c.
51; Act to amend the law relating to criminal and dangerous lunatics in
Scotland, 34 and 35 Vict., c. 55 (1871).

But we must retrace our steps to pursue the course of legislation a
little more in detail.

On the 3rd of February, 1818, a Bill for the erecting of district
lunatic asylums in Scotland for the care and confinement of lunatics,
brought in by Lord Binning and Mr. Brogden, was read the first time. A
few days after, a petition of the noblemen, gentlemen, freeholders,
justices for the peace, Commissioners of Supply, and other heritors of
the county of Ayr was presented against it, setting forth that the
petitioners, "from the first moment that they were made acquainted with
the principle and provisions of the proposed Bill, were deeply alarmed
for their own interests and those of Scotland in general, by the
introduction of a measure uncalled for and inexpedient, novel in its
application and arrangement, and substituting regulations of compulsion,
to the exclusion of the more salutary exertions of spontaneous charity,
and this, too, at a time when, by the gradual progress of enlightened
philanthropy, so many admirable institutions have been so lately
established in various parts of Scotland by voluntary contributions; and
that the petitioners are most willing to pay every just tribute of
respect to the humane views which may have dictated the proposed
measure, but they are satisfied that it must have owed its origin to
exaggerated and false representations of the state of the lunatics in
Scotland, and an unjust and groundless assumption of a want of humanity
in the people of Scotland toward objects afflicted with so severe a
calamity. The House cannot fail to remark that the proposed Bill
recognizes a systematic assessment, which it has been the wise policy of
our forefathers to avoid in practice, and that, too, to an amount at the
discretion of Commissioners ignorant of local circumstances, and perhaps
the dupes of misinformation; entertaining, as the petitioners do, deep
and well-grounded repugnance to the means proposed for carrying this
measure into execution, partly injudicious and partly degrading to the
landholders of Scotland, for it does appear to be a humiliating and, the
petitioners may venture to say, an unconstitutional Act, which would
place the whole landholders in Scotland in the situation of being taxed
for any object and to any amount at the discretion of any set of
Commissioners whatever; the petitioners therefore, confiding in the
wisdom of the House, humbly pray that the proposed Bill for providing
places for the confinement of lunatics in Scotland may not pass into
law."

Another petition against the Bill, from the magistrates and council of
the royal burgh of Ayr, was presented and read, praying that the same
may not pass into a law; or that if the House should think proper to
pass the said Bill, they would exempt the burgh and parish of Ayr from
its enactments.

Later on, another petition of the magistrates and town council of the
royal burgh of Montrose was presented against the Bill; and subsequently
one from Stirlingshire, Renfrew, Wigton, Edinburgh, Elgin, Glasgow,
Perth, Dumfries, and many other places.

The second reading was again and again deferred until the 1st of June,
when it was ordered "that the Bill be read a second time upon this day
three months." Thus persistent obstruction triumphed.

Sir Andrew Halliday, who took from an early period a lively interest in
the insane, writes in 1827: "I cannot but regret that the public refused
the adoption of a law for erecting district or county establishments,
proposed some years ago by that excellent nobleman, Lord Binning. The
rejection of this Act arose, I believe, neither from the parsimony nor
the poverty of the freeholders, but from a dread of introducing into the
kingdom that system which has been denominated the nightmare of England,
the poor's rates."[228]

How much legislation was needed at this period is well shown by the
description, by a philanthropist, of the condition of the lunatics in
the Perth Tolbooth, for which I am indebted to the late lamented Dr.
Lauder Lindsay, who observes: "Here is exactly what Mr. J. J. Gurney
says, and it is of special interest to us, as showing the sort of
provision made for the comfort of our local insane prior to the
establishment of the Murray Royal Institution in 1877, nine years
afterwards. In all probability Mr. Gurney's report, which was published
in his 'Notes on a Visit made to some of the Prisons of Scotland,' led
directly or indirectly to Mr. Murray's fortune being devoted to the
institution of an Hospital for the Insane. 'The old Jail of Perth is
built over a gateway in the middle of the town. Although this dark and
wretched building had been for some time disused as a prison, it was not
at the period of our visit' (Mr. Gurney's sister, Mrs. Fry, accompanied
him) 'without its unhappy inhabitants. We found in it two lunatics in a
most melancholy condition; both of them in solitary confinement, their
apartments dirty and gloomy; and a small dark closet, connected with
each of the rooms, filled up with a bed of straw. In these closets,
which are far more like the dens of wild animals than the habitations of
mankind, the poor men were lying with very little clothing upon them.
They appeared in a state of fatuity, the almost inevitable consequence
of the treatment to which they were exposed. No one resided in the
house to superintend these afflicted persons, some man, living in the
town, having been appointed to feed them at certain hours of the day.
They were, in fact, treated exactly as if they had been beasts. A few
days after our visit, one of these poor creatures was found dead in his
bed. I suppose it to be in consequence of this event that the other,
though not recovered from his malady, again walks the streets of Perth
without control. It is much to be regretted that no medium can be found
between so cruel an incarceration and total want of care.'"

A return, signed "H. Hobhouse," was made in this year (1818) from the
parochial clergy in Scotland, showing the number of lunatics in each
county, and other particulars, which now possesses considerable interest
historically. The most important figures are as follows:--

TABLE

SHOWING THE NUMBER OF INSANE, ETC., IN THE SCOTCH SHIRES IN 1818 AND THE
NUMBER IN ASYLUMS.

From this table it will be seen that the total number was 4628, of whom
2304 were males and 2324 females. With regard to their distribution,
there were--

In public asylums 258
In private asylums 158
With friends 1357
At large 2855
----
Total 4628

Two thousand one hundred and forty-nine were maintained wholly or in
part by the parish. Fifty parishes failed to send any return. In one
parish in the city of Edinburgh, from which we have no return, were
situated the "Edinburgh Bedlam" and the Charity Workhouse. In these two
places were confined eighty-eight lunatics and idiots. From Glasgow the
returns did not include ninety-five lunatics and idiots confined in the
Glasgow Asylum and Towns Hospital; 187 patients must therefore be added
to the foregoing, making a total of 4815.

Considering the period at which it was made, this is a very remarkable
return, and was much more complete than some later ones; for instance,
in 1826 the Parliamentary returns were ridiculously below these figures,
and Sir Andrew Halliday could only after diligent inquiry bring up the
number to 3700.[229]

Two years later (1828), a Bill was brought into the House of Commons to
amend the Act 55 Geo. III., c. 69,[230] by the Lord Advocate, Mr. H.
Drummond, and Mr. Robert Gordon. It passed the House of Lords, and
received the royal assent June 27th.

This constituted the Act 9 Geo. IV., c. 34, and reduced the fees paid
for persons confined from L2 2s. to 10s. 6d.; admission and discharge
books were ordered to be kept in every asylum, and an entry made of
every act of coercion; the books of the asylum were to be submitted to
the inspectors; no insane person was to be received into a hospital
without a warrant from the sheriff, who was to inspect hospitals; houses
were to be visited by medical men--those containing less than one
hundred patients, in case such house should not be kept by a physician
or surgeon, were to be visited twice in every week by a physician or
surgeon--signing in a register the condition of the house and state of
health of the patients; a register was also to be kept by the resident
physician or surgeon, and such register was to be regularly laid before
the inspectors, who were required to sign the same in testimony of its
production; ministers were empowered to visit mad-houses in their
parishes; regulations were made as to persons with whom lunatics were
privately confined; the justices might appoint three of their number to
inspect hospitals and private mad-houses; lastly, a weekly register was
to be kept in each house, and to be laid before the inspectors, stating
the number of curable and incurable cases, and the number under
restraint, the necessity thereof being certified by a medical man.

I wish to record here that, so far back as 1838, some of the Scotch
asylums were remarkable for the extent to which labour was introduced.
Being engaged in writing an introduction to Jacobi's work "On the
Construction of Asylums," the editor (Mr. S. Tuke) visited the asylums
of Scotland in that year, accompanied by Mr. Williams, the visiting
medical officer of the York Retreat, and found at Perth, Dundee, and
Aberdeen, the men's wards nearly empty, so large a proportion of their
inmates were in one way or other engaged in labour. "At Perth," he
writes, "more than twenty came in together to dinner from the labours of
the farm; others were employed in the garden and about the premises. At
Dundee at nine o'clock in the morning, out of fifty-seven men patients
of the lower class, twelve were engaged in stone-breaking, eight in
gardening, thirteen in weaving, one in tailoring, two as shoemakers,
whilst a few were engaged in the preparation of tow for spinning, and
several in the various services of the house. In the Aberdeen Asylum, in
which the labour system is extensively introduced, we were particularly
pleased with the state of the lowest class of women patients--chiefly in
an idiotic and demented state. All of these but one, and she was in a
state of temporary active mania, were employed in picking wool or some
other simple occupation. Indeed, in the three asylums which I have just
mentioned, the state of the lowest class of patients offers a striking
contrast to that in which they have been usually found in our asylums.
Those dismal-looking objects, cringing in the corners of the rooms or
squatting on the ground, almost lost to the human form, are here not to
be seen. I must not omit to mention that at Aberdeen the manager had
succeeded in inducing the higher class of patients to engage in
gardening, etc. At Glasgow the governors were contemplating arrangements
for the more extensive introduction of the labour system. In all these
asylums the superintendents expressed their decided conviction of the
benefit which, in a great variety of ways, was derived from the
employment of the patients, more especially in outdoor labour."

In connection with the Dundee and Glasgow asylums, the great services
rendered by Dr. McIntosh ought not to be forgotten, as also those of Dr.
Poole (Montrose), Dr. Malcolm (Perth), and Dr. Hutcheson (Gartnavel).

Scotland south of Edinburgh and Glasgow had not, until 1839, any
retreat or place of confinement for the insane, except six squalid stone
cells attached to the public hospital of Dumfries. Violent or vagrant
lunatics were physically restrained in their own houses, allowed to roam
at large, or incarcerated in prisons or police stations. In the year
mentioned, the Crichton Institution was opened for the reception of
patients of all ranks and means, from the pauper to the peer, in other
words, at rates of board from L17 to L350. In those days the building
was regarded as magnificent, commodious, and much in advance of the
prevalent psychiatry in Scotland, in the provision for the restoration
of mental and physical health, and for securing the comfort and
happiness of the inmates. The funds providing this building and
surrounding fields, had been bequeathed by Dr. Crichton, of Friars
Carse, Dumfriesshire, to his widow, who determined the precise
application of the magnificent legacy, which it is reported amounted to
L120,000. The benevolent foundress caused the structure to have the
Bible as a foundation, instead of a stone, and announced her solemn
intention that the establishment should be conducted, not merely in
accordance with science, but the principles of Christian philanthropy.
The first medical superintendent, Dr. W. A. F. Browne, who had made a
critical examination of European asylums, and had acted as the chief
officer in the Montrose Lunatic Asylum during four years, opened the
Crichton Institution in 1839, with what were regarded as sound but
advanced views, and with the resolution of carrying into effect all
that had been discovered or suggested for the amelioration, cure, and
care of those who might require treatment or seclusion.

Before the close of the first year of his management, there would appear
to have been about a hundred individuals, of various stations and in
various mental conditions, consigned to his charge. For these and the
gradually increasing numbers of the population, he instituted daily
exercise, amusement, occupation in the open air and in the grounds of
the establishment, and during winter or inclement weather, billiards,
bagatelle, "summer ice," and walking in the protected balconies
connected with every ward or gallery in the house. Collections of books
were contemporary with the laboratory, and the medical officers
invariably carried a catalogue, along with a prescription book, in their
daily medical visits to every patient. As a rule, remuneration was
ordained for every description of labour, whether it was mental or
manual, and might take a pecuniary or honorary form. From the
commencement no personal restraint was resorted to, although the medical
director did not bind himself either by rules or avowed opinions to
prohibit mechanical resources, should they appear to be demanded for the
preservation of life or strength, or quiet, or in any respect as a
remedial agent. In 1840 a medical assistant or pupil was appointed. The
experiment proved eminently successful, and the course thus foreshadowed
has been universally adopted, and improved upon by increase in the
number of such fellow labourers, by the addition of clinical clerks, and
so forth. The next advance was in instituting recorded observations of
the state of patients during the night as well as the day; in the
addition of carriages as a means of enjoyment and distraction, one of
these being an omnibus, so that groups of the inmates might be conveyed
to distant parts of the surrounding country; and in the multiplication
of hygienic and moral influences, music, painting, translation, study of
medicine, acquisition of languages, teaching, reading prayers, etc. The
next stage of development may be described as the separation of
different classes of patients; provision for the agitated, for
abstainers; mental culture for all capable of receiving impressions,
lectures, public readings, the production of a monthly periodical which
is still continued. Of this institution we shall have to speak again.

An Act to alter and amend certain Acts regulating mad-houses in
Scotland, and to provide for the custody of dangerous lunatics, was
passed in June, 1841 (4 and 5 Vict., c. 60). It amended 55 Geo. III., c.
69, and 9 Geo. IV., c. 34. A penalty of L200 and the expenses of
recovering the same might be imposed on persons sending any lunatic to a
mad-house without a licence; persons convicted of receiving lunatics
without a licence, or the required order, might be imprisoned in default
of penalty; the sheriff on application of the Procurator Fiscal might
commit dangerous lunatics; the expenses were to be defrayed out of the
rogue money, if the person had not the means of defraying, or if it
could not be recovered out of his estate, then the same was to be
defrayed by the parish which would be liable for the maintenance of
such lunatic if he or she were a pauper; lunatics might be removed on
application by the Procurator Fiscal; parish pauper lunatics were to be
confined in public hospitals; if no public hospital in the county, the
sheriff might send lunatics to an adjoining county; the death of a
lunatic was to be intimated to the sheriff in writing by the person
keeping the licensed mad-house; fees of licences might be diminished if
the moneys received exceeded the sums required for carrying this Act
into execution.

A form of register was to be kept in all licensed mad-houses in
Scotland, indicating the house; where situated and kept; names and
designations of individuals confined; date of reception; at whose
instance confined, and on whose medical certificate; whether curable or
incurable; date of removal or discharge, and authority for either; date
of death; disease or cause of death, and duration of disorder; name of
medical practitioner; when first called to give special attendance, and
how often he afterwards visited the deceased, with the place of burial.

We must not omit to mention that in 1848 further legislation was
attempted--an attempt, the failure of which was frequently deplored in
the debates of succeeding years. A good Bill designed to amend the law
of Scotland relative to the care and custody of the insane, and to
regulate existing asylums, and to establish asylums for pauper lunatics,
was brought in by the Lord Advocate (Lord Rutherfurd), Sir George Grey,
and the Secretary at War. After the second reading it was referred to a
Select Committee, which included the names of the Lord Advocate, Lord
Ashley, Sir James Graham, Mr. E. Ellice, Mr. Stuart Wortley, and Mr. H.
Drummond. Petitions now poured in from almost every shire in Scotland,
and the Bill had unfortunately to be withdrawn. Undaunted, the Lord
Advocate made another attempt in the following year, but with the same
result.

It is not necessary to dwell longer on the condition of the insane, or
the legislation adopted on their behalf, till we come to the year 1855,
which proved to be the commencement of a new departure in the care taken
for them by the State. Unfortunately, in spite of legal enactments, the
state of the insane in Scotland, at this time, outside the asylums was
as bad as it could be, and even in some asylums it was deplorable. At
this period a well-known American lady, Miss Dix, who devoted her life
to the interests of the insane, visited Scotland, and the writer had the
opportunity of hearing from her own lips, on her return from her
philanthropic expedition, the narration of what she saw of the cruel
neglect of the pauper lunatics in that country. She caused so much
sensation by her visits and her remonstrances, accompanied by the
intimation that she should report what she had witnessed at
head-quarters in London, that a certain official in Edinburgh decided to
anticipate "the American Invader," as Dr. W. A. F. Browne called her.
Miss Dix was, however, equal to the occasion, and, hurriedly leaving the
scene of her investigations, she took the night mail to London, and
appeared before the Home Secretary on the following day, when the
gentleman from Edinburgh was still on the road, quite unconscious that
the good lady had already traversed it.[231] The facts she laid before
the Home Office were so startling that they produced a marked effect,
and, notwithstanding counter allegations, the conclusion was very soon
arrived at that there was sufficient prima facie evidence to justify
an inquiry. A Royal Commission was appointed, dated April 3, 1855, "to
inquire into the condition of lunatic asylums in Scotland, and the
existing state of the law of that country in reference to lunatics and
lunatic asylums."

The statutes forming the code of lunacy law for Scotland at that period
were, for all practical purposes, the 55 Geo. III., c. 69; 9 Geo. IV.,
c. 34; and 4 and 5 Vict., c. 60.

The number of ascertained patients at this period (1855) amounted to
7403. The classification was as follows:--Private patients, 2732;
paupers, 4642; criminals, 29 = 7403. Curable, 768; incurable, 4032;
congenital idiots and imbeciles, 2603 = 7403. Males, 3736; females, 3667
= 7403. The proportion of the insane and idiots to the population was 1
in 390. The number of congenital idiots was greatest in proportion to
the population in those counties remote from influences that incite to
mental activity--the Highland population containing more than three
times the number found in an equal Lowland population.

This Commission did not report until 1857, and unhappily the evidence
more than justified the necessity of the appointment of the Committee,
and of a sweeping measure of reform. The difficulty in selecting
passages from the Report is to know where to stop. We shall restrict
ourselves within moderate bounds; and first let us cite the reference to
the condition of the insane and idiotic not in asylums. "It is obvious,"
says the Report, "that an appalling amount of misery prevails throughout
Scotland in this respect. When estimating the condition of the insane
not in establishments, it should be remembered that the details
furnished by us give only an imperfect representation of the true state
of matters. They form only a part of the picture of misery; and, had we
been able to extend our investigations, it would, we are convinced, have
assumed a much darker shade.

"A practice prevails in some workhouses, as in a few of the licensed
asylums, of fastening the hands behind the back, by which much
unnecessary pain is inflicted on the patient."

Of the methods employed in asylums to repress violence, etc., the
Report thus speaks:--

"Instrumental Restraint and Seclusion.--Personal restraint by the
application of the strait waistcoat, or of the straps or muffs, is
almost entirely banished from the chartered asylums; but we have reason
to think that seclusion for long periods is frequently used. This remark
applies more especially to the asylums of Montrose, Glasgow, Aberdeen,
and Edinburgh. In Montrose we found, on one occasion, eleven patients in
seclusion out of a population of 174, several of them having been so
secluded for considerable periods, and one woman for several months; and
it is to be observed that the seclusion rooms in this asylum are mere
cells, with stone floors and darkened windows, and that the patients
who are placed in them are frequently allowed no other covering than
blankets, and no other bedding than loose straw cast on the floor."

Here is a picture of the way in which one asylum was conducted: "We have
grounds for fearing that the patients suffered from cold. The house is
carelessly conducted and the state of the patients very unsatisfactory.
The bed-frames, which are about the ordinary size with only spars of
wood at the lower part, were dilapidated and saturated with filth; and
the quantity of straw in them was very scanty and mixed with refuse; it
was wet, offensive, and broken into small portions, and had clearly not
been renewed for a considerable time. A certain number of the patients,
males as well as females, were stripped naked at night, and in some
cases two, and in one case even three, of them were placed to sleep in
the same bed-frame, on loose straw, in a state of perfect nudity." The
proprietor in his evidence says, "I never go into the rooms at night.
The floor is constantly soaked with wet. There is an epileptic lad who
is frequently fastened to the rings in the wall. The nurses keep the
muffs in their custody. I dare say half of the dirty patients would
sleep naked; seven would, therefore, sleep with others, I cannot say
that more did not sleep together in a state of nudity. I consider the
treatment is proper for them."

Again: "The bad treatment of the patients, and the very unsatisfactory
treatment of the patients, are not fully known to the official
inspectors. Indeed, it would appear that in some houses the instruments
of restraint are systematically removed from the persons of the patients
after the arrival of the sheriff at the asylum, for we find in Dr.
Renton's evidence that, speaking of L---- Asylum, in which two male
patients are kept constantly in restraint by means of handcuffs, he
says, 'There are not many patients under restraint at L----.' And,
further, in reference to Mrs. B----'s house at N----, he states, 'In
Mrs. B----'s house I don't think there are many cases of restraint.
There is a Miss W---- lately come, and a Miss M----. I don't think
restraint is used to them.' We have ascertained, however, that these two
patients were frequently restrained. These instances might be
multiplied.

"Rent is saved by placing patients in small houses, making them use
the same rooms both as day and sleeping accommodation; they are also
crowded into small airing-courts, inadequate to afford proper exercise
and a proper separation of the sexes. The inmates during the winter
months pass the greater part of each twenty-four hours in their bed,
whereby candle-light is saved. In L---- Asylum, the patients are not
allowed candle-light at any season.

"We cannot doubt that in many instances practices obviously wrong, and
detrimental to the patients, have been adopted in licensed houses,
because an increased profit would thereby be obtained by the
proprietor."

In short, both as regards licensed houses and unlicensed houses, the
Report winds up by giving a dismal picture; for, as to the former, "they
are crowded in an extreme degree, profit is the principal object of the
proprietors, and the securities against abuse are very inadequate;" and
as to the latter, they "have been opened as trading concerns, for the
reception of certain classes of patients who are detained in them
without any safeguard whatever against ill-treatment and abuse." Strange
to say, the persons properly authorized to inspect, did not avail
themselves of the powers of inspection granted them by law; and the
officials chose to interpret the law "in conformity with their
respective views." Such was the unfortunate condition into which Scotch
lunacy had drifted, at so comparatively recent a date as 1857, and out
of which those who drew up the Report--Alexander E. Monteith, James
Coxe, Samuel Gaskell, and William George Campbell--proposed to deliver
it by the following remedial measures:--The erection of district or
county asylums for pauper lunatics, including accommodation for the
insane belonging to the labouring classes, who are not strictly
paupers. Likewise, more suitable accommodation for criminal lunatics.
Means for insuring greater caution and discrimination as regards the
licensing of houses for the reception of the insane; for imposing some
check upon the licensing of new houses; and for conferring powers to
close those already opened for paupers so soon as public asylums shall
be erected, or at any other time, if not properly conducted. Regulations
by which all pauper lunatics not in asylums shall be brought under
proper visitation and care, and periodical reports be made as to their
condition by medical men, so as to afford a safeguard against abuse and
ill-treatment, and secure the ready and careful transmission of all
proper cases to asylums. An accurate definition of the powers and duties
of sheriffs in reference to the insane, so as to secure a more uniform
practice and united action amongst them. Rules for the guidance of the
Board of Supervision, parochial boards, inspectors of poor, and district
medical officers in all matters relating to the management of the
insane. More complete regulations in reference to medical certificates;
to prevent interested parties signing them; to specify the length of
time the document shall remain in force; and to require a statement of
the facts or evidence upon which the opinion as to the patient's
insanity is founded. Also a limitation of the time during which the
sheriff's order shall remain in force, previous to the admission of the
patient, and also in case of escape. The formation of a complete system
of schedules and returns, together with full records of all admissions,
discharges, deaths, and accidents. Also the institution of registers
and case-books, showing the medical treatment pursued in each case, and
whether, and to what extent, restraint and seclusion were employed.
Comprehensive regulations applicable to licensed houses and poor-houses,
while continuing to receive lunatics, for securing to the patients
sufficient medical and other attendance; kind and appropriate treatment;
proper diet, clothing, bedding, exercise, and recreation; and adequate
means of religious consolation. A requirement that, on recovery,
patients shall be discharged by the medical attendant of the
establishment. Restrictions on the removal of pauper patients by
inspectors before recovery. Precautions for preventing injustice in
transporting aliens. Better regulations as to dangerous and criminal
patients. Measures by which persons labouring under insanity may
voluntarily place themselves under care in an asylum. Special
regulations for prolonging control over cases of insanity arising from
intoxication. Enactments for extending further protection to the
property of lunatics, and for insuring the proper application of their
funds. The imposition of suitable penalties for infringement of the law,
and power to modify them according to circumstances. Powers to raise
sufficient funds for the purposes of the Act. The creation of a
competent board, invested with due authority, to whom the general
superintendence of the insane in Scotland shall be entrusted, including
power to license houses for the reception of the insane; to visit all
asylums, licensed houses, poor-houses, and houses containing only single
patients; to order the removal of patients to or from an asylum, or
from one asylum to another; to give leave of absence to convalescent
patients; to regulate the diet in asylums and licensed houses for pauper
patients; to make regulations for their management, etc., etc.; with
direction to report to the Secretary of State for the Home Department.
The formation of local boards for the management of individual asylums,
which shall act in conjunction with the general board.

Legislation followed in due time.

On the 29th of May, 1857, Mr. Ellice,[232] the member for St. Andrew's,
asked the Government what steps they intended to take for securing to
pauper lunatics in Scotland proper protection and maintenance, in order
to alleviate the sufferings of the persons to whom the recent Report of
the Commissioners of Inquiry into the state of Lunatics in Scotland
related. He was ashamed to have to admit that in that country,
unfortunately, the state of things had been lamentably different from
England and Ireland, where boards had been appointed under which,
generally speaking, the law for the protection of lunatics had been
satisfactorily administered. In Scotland, instead of a Board of
Commissioners specially appointed to take care of lunatics, the charge
had devolved upon the sheriffs of counties and the Board of Supervision,
which latter body stood in the place of the Poor Law Board in this
country. He charged the Scotch authorities with an almost total neglect
of the duties which were incumbent upon them under the law, which "in a
great measure was very ample for the protection of the great proportion
of the pauper lunatics in Scotland, if it were properly administered."
The powers and duties of the sheriffs, as laid down in the Act, were
amply sufficient. Yet the granting of licences, which was their duty,
formed the exception, and, in fact, houses were opened generally without
any licence whatever; the patients were detained without any order, or
without even any medical certificate; if they died, their friends were
not informed of their deaths, which were not reported to any constituted
authority, "the unfortunate persons disappearing in that mass of misery
and filth which he should shortly depict." The pauper lunatics were
under the charge of the parochial boards. These were under the control
of the Board of Supervision, sitting in Edinburgh, and similar to the
Poor Law Board in London. The statute enacted that whenever any poor
person chargeable on the parish should become insane, the parochial
board should, within fourteen days of his being certified, take care
that he was properly lodged in an asylum. The Board of Supervision had,
under the same Act, peculiar power with respect to lunatics, and it was
competent for them to dispense with an asylum, and allow the patient to
remain with his friends under due inspection.

The Board of Supervision had absolute powers to dismiss any inspectors
of the poor neglecting their duty to pauper lunatics. They acknowledged
their obligation. In their first Report (1847) they, among other
positive statements, affirm that they, in all cases in which they
dispensed with the removal of pauper lunatics to asylums, were careful
to preserve the necessary safeguards against abuse, by requiring a
satisfactory medical certificate as to treatment, and so on. Mr. Ellice
then showed that "these statements had no foundation in fact; that they
were positively untruths, and entirely deceptive, year after year, as to
the real state of the lunatics in Scotland." In subsequent Reports the
Board boasted that it had endeavoured, not unsuccessfully, to improve
the condition of the insane, but Mr. Ellice showed that "the condition
and treatment of the pauper lunatics was diametrically opposite to what
was there stated." He knew that more legislation would be promised by
the Government, but the thing was to see that the law was enforced, and
that due notice should be taken of the conduct of the authorities who
had neglected their duties. He asked that a direct condemnation should
be passed upon them, and that they should be compelled, as in duty
bound, to protect pauper lunatics from continued neglect and abuse. The
member for Aberdeen characterized the Report of Commissioners regarding
the state of the insane in his county as "one of the most horrifying
documents he had ever seen."[233] It was "a state of things which they
could not before have believed to prevail in any civilized country, much
less in this country, which laid peculiar claims to civilization, and
boasted of its religious and humane principles."[234] "Distressing as
were the cases which he had mentioned, there were others ten times worse
remaining behind--so horrible, indeed, that he durst not venture to
shock the feelings of the House by relating them."[235] Sir George Grey,
after saying that the Report on the treatment of lunatics in Scotland
contained statements of facts calculated to cast very great discredit
upon that portion of the United Kingdom, admitted that the Board of
Supervision was not free from blame, but thought the Report proved that
the guilt must be shared by the parochial boards, the inspectors of the
poor, the sheriffs, the clergy, the justices of the peace, and by the
Commissioners of Supply. By this ingenious homoeopathic dilution of the
blame, it was easy to show that individual responsibility was
infinitesimal, and could not, therefore, be detected and punished in the
way it so richly merited. Sir George Grey promised to introduce a Bill
calculated to remove the defects in the law established by the Reports,
and deplored the fate of the Bill brought in by Lord Rutherfurd,[236]
when Lord Advocate, which would, in his opinion, have remedied all the
evils now complained of. It was "referred to a Select Committee, but the
opposition roused to it in Scotland, on the miserable ground of the
expense it would incur, proved fatal to the measure. I trust the
disgrace that now attaches to Scotland in this matter will be removed,
and that this and the other House of Parliament will cordially
co-operate with the Government in the adoption of those measures that
are necessary for the relief and protection of the unfortunate class of
persons referred to in the Report."[237] Mr. H. Drummond, who said he
had assisted Lord Rutherfurd to pass his Bill, also deplored its
rejection. "Both he and the Lord Advocate were beaten by the systematic
opposition of every single person who was connected with the
administration of the system in Scotland. They would not give the
returns sought for ... and the ground of the opposition was the dread of
the dirty expense which might be incurred. From one to the other it
appeared that the object of care in Scotland was property, not persons.
The way in which they treated the poor in Scotland was perfectly
scandalous, and in nothing did the system appear so bad as in the
treatment of pauper lunatics, the rich lunatics being sufficiently well
taken care of." Mr. Drummond asked how it was "that throughout the whole
of Scotland there was not one clergyman who could find time to visit
these poor creatures? True, there was one, but when he went to the
asylum he was refused admittance; and why? Because he was a Papist. The
Poor Law, as managed by the Board of Supervision, had been well defined
to be 'a law for depriving the poor of their just rights.'"[238] Sir
Edward Colebrooke, as one of the members for Scotland in the previous
Parliament, took his share of the blame that attached to the House in
reference to Scotch asylums. In the Report issued in 1844, it was
recommended that more stringent provisions should be introduced into the
law, but they had not been attended to. Mr. Kinnaird, the member for
Perth, thought that the Scotch members owed a debt of gratitude to Mr.
Ellice for the manner in which he had laid the disgraceful feature in
the administration of the Scotch Poor Law before the House. He was glad
to find that the Perth Asylum was not one which had disgraced
Scotland.[239] The Lord Advocate rejoiced at the publication of the
Report, and the statements of Mr. Ellice, from the bottom of his heart,
because the state of things had for a long time been a disgrace and a
scandal to Scotland. "The people of that country had known that it was a
disgrace and a scandal, and he regretted to add that it was not the
first time that statements had been made similar to those to which they
had just listened. Had Lord Rutherfurd's Bill of 1848 been passed, this
disgraceful state of things would have been put an end to. But not a
single petition was presented in its favour, while twelve of the largest
and most important counties of Scotland petitioned against it! That
noble-minded lady, Miss Dix, went to Edinburgh and visited the asylums
at Musselburgh. After seeing them, she said there was something wrong,
and she wished to be allowed to visit them at the dead of night, when
she would not be expected. He felt a difficulty about giving a
permission of that kind to a non-official person, and accordingly she
applied to the Home Secretary. When asked by him his opinion of the
subject, he at once stated that the whole system with regard to the
treatment of lunacy in Scotland was utterly disgraceful, and that the
evil could only be reached by a Commission of Inquiry. The facts were
now so clearly proved that if he proposed the very remedy which was
rejected in 1848, it would be adopted by both Houses of Parliament
without any important opposition."

A Government Bill was brought in by the Lord Advocate, June 9, 1857, "to
alter and amend the laws respecting lunatics in Scotland." In
introducing it, he summarized the then law as follows:--The sheriffs of
the counties, the justices, and some other parties had the power and
duty of inspection once or twice a year; certain registers were ordered
to be kept and certain regulations made. But there was no uniformity;
every sheriff might interpret the Act as he pleased, and there was no
obligation to erect asylums for the maintenance of lunatics. The duty
was thrown on the Procurator Fiscal of seeing the Act executed, but no
power was given him to ascertain whether it was executed or not, and
there was no power of visitation. He need not say that these safeguards
entirely failed, and the remedy he now proposed was that there should be
appointed a Commission, an inspector-general who should be a medical
man, a secretary, and a clerk; and that these should constitute the
Lunacy Board for Scotland, though not under that name. They would have
the power of granting and refusing licences for asylums. The sheriffs
and the justices would retain the powers conferred on them already.
Scotland would be divided into districts, in which asylums would be
erected by an assessment laid on for the purpose. The Lord Advocate made
a sort of formal defence of the Board of Supervision, of which he
himself had been a member, and pointed out that in their first Report
they had stated that the accommodation in the asylums was not equal to
that required for one-tenth of the number of pauper lunatics. Sir John
McNeill, who presided over the Board, when examined before the Select
Committee on Miscellaneous Expenditure in 1848, stated this fact
strongly. Mr. Ellice, however, adhered to the remarks he had previously
made, reasserted his accusations, and repeated that if the question were
put to a jury, they would come to no other decision than that gross
culpability existed on the part of the authorities, and he only
regretted that the Government had not had the courage to say that the
Board of Supervision had deserved the condemnation of the House. Leave
was given to bring in the Bill.[240]

On the second reading[241] (June 9, 1857) no serious opposition was
offered to the Bill, although an attempt was made to show that the
Commission had been carried away by exaggerated statements. Mr. Bruce,
the member for Elginshire, who alleged this, hoped the Bill would not be
hurried through the House that session. Mr. Blackburn, the member for
Stirlingshire, said he agreed with every Scotch member that a permanent
board would be of no use; it would be coercing the people by
centralization. Mr. Cowan, member for Edinburgh, said that he had been
requested to present a petition, signed by the Lord Provost and
magistrates of Edinburgh, seeking for delay, but he did not like to
incur that responsibility, and would therefore support the second
reading. Mr. Dunlop, the member for Greenock, assumed, for the sake of
argument, that all persons in Scotland had done their duty; but even if
this were so, it was impossible but that cruelty and ill-treatment must
have taken place when they considered the way in which pauper lunatics
were treated, and he rejoiced that another session was not likely to
pass over without something being done to remove what was at once a
national calamity and a national crime, from Scotland.[242] Mr. Mackie,
the member for Kirkcudbrightshire, protested against the creation of a
new Board and the expensive machinery contemplated by the Bill. Sir
William Dunbar, the member for Wigton, agreed, and maintained that the
existing system was sufficient to insure all that was required. Sir John
Ogilvy, member for Dundee, said a strong feeling existed in Scotland
that the Board of Supervision furnished an efficient machinery capable
of supplying all the defects of the present system, without the creation
of a new Board. Mr. Hope Johnstone, member for Dumfriesshire, enforced
these remonstrances, by stating that he had representations made to him
from every quarter in opposition to the appointment of a new Board. Mr.
Drummond hereupon made an observation, greatly to his credit, which
deserves to be remembered. He said that the question was not so much
what would be the most expensive as what would be the most efficient
machinery. There were plenty of representatives of the ratepayers in
that House, but no representatives of the lunatics of Scotland. They
seemed to have no friends there, while really they were the persons who
stood most in need of being represented.

The Act (20 and 21 Vict., c. 71) was passed August 25, 1857. It was
entitled "An Act for the Regulation of the Care and Treatment of
Lunatics, and for the Provision, Maintenance, and Regulation of Lunatic
Asylums in Scotland." It repealed the Acts 55 Geo. III., c. 69; 9 Geo.
IV., c. 34; and 4 and 5 Vict., c. 60.

To give a complete analysis of this most valuable Act, which consists of
no less than 114 sections, would be wearisome to the reader. Its chief
provisions were these:--

A Board of Commissioners in Lunacy for Scotland was to be appointed,
consisting of three unpaid and two paid Commissioners; the Secretary of
State was empowered to appoint one or two medical men as Deputy
Commissioners; public asylums founded after the passing of this Act were
to be subject to it; the duties of the Commissioners as to inspection
were laid down; the sheriff was to visit and inspect asylums; private
asylums were to be licensed by the Board; the patient was to be admitted
by order of the sheriff on medical certificates; five shillings were to
be paid for the sheriff's order for the admission of a patient not being
a pauper, and half that sum for a pauper; the medical certificate was to
specify the facts on which opinion of insanity was founded; no
certificate was to be granted without examination, under penalty not
exceeding L50, and if falsely granted, under a penalty not exceeding
L300; houses where lunatics were detained under the order of the
sheriff might be visited by the Board; one medical man was to be
resident in every asylum licensed for a hundred patients or more, and a
physician was obliged to visit daily those for more than fifty patients;
those for fifty or less were to be visited at least twice in every week.

Scotland was divided into districts, set forth in a schedule, and a
district board was to be appointed within six months, which should
inquire into the necessities of the district; the Board was to require
the district boards to provide district asylums; the provisions of 2 and
3 Vict., c. 42, were to be applied to this Act; district asylums were to
be vested in district boards, and district inspectors were to be
appointed.

Power was given to Public Works Loan Commissioners to lend money for
purposes of the Act, provision being made for the money borrowed being
paid off within thirty years.

In case the district asylum could accommodate more than the lunatics of
the district, other lunatics, it was enacted, might be admitted.

Whether the property of a lunatic was or was not under judicial
management, if it was not property applied for his benefit, application
was to be made to the Court of Session.

Provision was also made for cases where insanity stands in bar of trial;
the finding of the Court that the prisoner cannot be tried, to be
followed by an order to be kept in strict custody during her Majesty's
pleasure; a lunatic acquitted of a criminal charge on the ground of
insanity, to be kept in custody by order of court in such place as it
may see fit, during her Majesty's pleasure; prisoners exhibiting
insanity when in confinement to be removed to an asylum, to remain there
until it should be certified to one of her Majesty's Principal
Secretaries of State by two medical men that such person has become of
sound mind; whereupon the Secretary of State was authorized, if such
person's term of imprisonment had not ended, to issue his warrant to the
superintendent, directing that such person should be removed back to
prison, and if no longer subject to imprisonment, that he should be
discharged.

With regard to the liberation of patients from asylums, the certificates
of two medical men approved by the sheriff were required, eight days'
notice being given to the person at whose instance such lunatic was
detained; the patient released to be entitled to a copy of order,
certificate, etc., on which he was confined.

The punishment of maltreating any lunatic was a fine not exceeding L100,
or imprisonment for any period not exceeding six months, without
prejudice to action for damages.

Power was granted to the Secretary of State to order a special
visitation of any place where a lunatic was represented to be confined.

The inspectors of the poor were to give intimation of pauper lunatics
within their parishes.

The importance of this Act is enhanced by the fact that its framers had
the advantage of a knowledge of the working of the great Acts of 1845
and 1852 in England and Wales.

Availing ourselves now of the first Report of the Commissioners[243]
who were appointed under the foregoing Act, we shall present a statement
of the number and distribution of the insane in Scotland on the 1st of
January, 1858.

The above table does not include private single patients; their number
could not be accurately ascertained.

The Commissioners, as might be expected, report the state of the insane
to have altered little since the Report of the Royal Commission. In the
pauper licensed houses, if not in others, the overcrowding was great,
though diminishing. "The patients, when within doors, are generally
found sitting in cheerless rooms, ranged on benches, listless and
without occupation; and when out of doors, they are usually lounging
sluggishly about the airing-courts, or are crouching in corners." Among
favourable indications noted by the Commissioners it is pleasant to read
the following:--"Mechanical restraint has been entirely banished from
the licensed houses, and patients who are recorded in the Report of the
Royal Commissioners as almost always under restraint, are now habitually
free from their bonds. The improvement in the condition of these cases
under the more humane treatment now in use has been most remarkable, and
is especially exemplified in the case of A. S----, a patient in M----
Asylum."

Subsequent Acts were passed, called for by the experience of the
Commissioners in regard to the working of the Act of 1857, some
imperfections in which were naturally discovered in the course of years.

The Lord Advocate and Sir George Grey brought in a Bill in 1862 to make
further provision respecting lunacy in Scotland, which received the
royal assent July 29 (25 and 26 Vict., c. 54).

By this Act, consisting of twenty-five sections, the Board was empowered
to license lunatic wards of workhouses; to sanction the reception of
pauper lunatics in workhouses; to grant special licences for reception
in houses of not more than four lunatics; to grant licences to
charitable institutions for imbecile children without fee; to sanction
detention of pauper lunatics in asylums beyond the limits of their
district; to take such steps as the Board may consider requisite towards
providing accommodation for the district, etc., etc. Not to cite other
sections, certain provisions of the recited Acts as were inconsistent
with the Act were repealed, and the General Board of Commissioners was,
of course, continued.

In their Report of this year (1862) the Commissioners observe, relative
to the supposed increase of insanity, "Judging from the evidence which
the tables afford, the increase is almost entirely due to the
accumulation of the numbers of the insane, and certainly not, to any
marked degree, to a greater disposition in modern times to mental
disease; for while in the years 1858, 1859, 1860, and 1861, the
admissions into asylums scarcely varied in number, the patients
resident in such establishments showed every year a large and steady
increase. Thus, on January 1, 1858, t